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Anterior nasal packing [advanced]

Introduction

  • Wash hands, Introduce self, Patients name, Explain procedure fully and get consent
  • Explain it will be uncomfortable and they may need to cough up blood pushed back down – give them a bowel

Gather equipment

Equipment list

  • 10% xylocaine spray (or 1% lidocaine in 2-5ml syringe sprayed fast from broken white needle)
  • Pack options
    • Nasal tampon (7.5cm ideal, also 5cm and 10cm available) e.g. Netcell nasal pack, Merocel
    • Inflatable pack (7.5cm ideal, also posterior pack available) e.g. Rapid Rhino
  • KY jelly
  • 10ml syringe (filled with saline if using nasal tampon, or air if using inflatable pack)
  • Tape
  • Paper towels
  • Cardboard bowl

Preparation

  • Apply gloves and apron
  • Spray anaesthetic into nostril

Nasal tampon insertion

  • Ensure nasal tampon has a suture attached at one end (if not, place one)
  • Put KY jelly all over nasal pack
  • With your non-dominant hand, push up on the tip of their nose
  • Then immediately insert the nasal tampon into nostril horizontally in the sagittal plane (see image)
  • Advance horizontally along the floor of the nasal cavity in one motion until maximum depth
  • The outer tip with suture attached should be next to the tip of the nose
  • Slowly expel the a few mls of saline from the syringe into the nostril to swell up the nasal pack like a tampon
  • Tape the string on their cheek
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Nasal tampon insertion

Inflatable pack insertion

  • Remove pack from its sleeve
  • Place in bowel of sterile water (not saline) for 30 seconds
  • With your non-dominant hand, push up on the tip of their nose
  • Then immediately insert the inflatable pack into nostril horizontally in the sagittal plane (see image)
  • Advance horizontally along the floor of the nasal cavity in one motion until maximum depth
  • The outer tip with suture attached should be next to the tip of the nose
  • Attach 10ml syringe full of air and inflate until pilot cuff is firm but with some bounce (no set volume)
  • Tape the tubing to their cheek

Further management

  • Full history and ABCDE assessment
  • Secure IV access and send bloods including FBC, G&S, clotting
  • Refer to ENT team for nasal cauterisation
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